HomeMy WebLinkAbout19687-zFORM NO. 4
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z19769 Date MARCH 4, 1991
THIS CERTIFIES that the building~ ACCESSORY BUILDING
Location of Property~ 35 FOUNDERS PATH SOUTHOLD
House No. Street Hamlet
County Tax Map No. 1000 Section 62 Block 03 Lot 27
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated FEB. 22, 1991 pursuant to which
Building Permit No. 19687Z dated MARCH 4~ 1991
was issued, and conforms to all of the requirements of the applicable
provisions of the law. The occupancy for which this certificate is
issued is METAL ACCESSORY SHED AS BUILT.
The certificate is issued to JOHN CONRAD
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A .
Building Inspector
Rev. 1/81
FORM ~0, 0
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HAIL
SOUTHOLD, No Y.
BUILDING PERMIT
(THIS PEP~IT MUST BE I~EPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WOP. K~ AUTHORIZED)
NO. 19687 Z ~ot....f~ ............... .~. ............... , ,~..~.../
Permission is hereby gronted to:
...£ ~ 8. ........... ~ ....
· ............................
..~....~/.~.,...~.....L.L~.
at premises located at ......... ~..~.........~....~...~- .~ ..............................
......................................... ..............
¢ou,~ To× Mop No. ~000 Sect,o. .... ...0...~.~.... ~oc~ ....~..~ ..... ~t No ..... ~...~ ....
pursuant to application dated ..... ..~...~ ........... ~...~......, 19..~...~ and approved by the
Building Inspector.
Rev. 6130/80
Form No. 6 ~ ~~_.~
TOWN OF SOUTHOLD ?~':'
'.~,
TOWN HALL _
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPAN~F~lj!~Q:-:'
This application must be filled in by typewriter OR ink and submitted to the building
inspector with the following: for new building or new use:
1. Final survey of property with accurate location of ail buildings, property lines,
streets, and unusual natural or topographic features.
2. Final Approval from Health Dept. of water supply and sewerage-disposal(S-9 form).
3. Approval of electrical installation from Board of Fire Underwriters.
4. Sworn statement from plumber certifying that the solder used in system contains
less than 2/10 of 1% lead.
5. Commercial building, industrial building, multiple residences and similar buildings
and installations, a certificate of Code Compliance from architect or engineer
responsible for the building.
6. Submit Planning Board Approval of completed site plan requirements.
For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and
"pre-existing" land uses:
i. Accurate survey of property showing all property lines, streets, building and
unusual natural or topographic features.
2. A properly completed application and a consent to inspect signed by the applicant.
If a Certificate of Occupancy is denied, the Building Inspector shall state the
reasons therefor in writing to the applicant.
C. Fees
1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00,
Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00,
Additions to accessory building $25.00. Businesses $50.00.
2. Certificate of Occupancy on Pre-existing Building - $100.00
3. Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
..~... Old Date .......
~:ew Construction ..... Or ~i~px:;)~ Bu~ ........... i ~,~ ~.~.
Location of Property ....... ~ .~... P.~..,.~::,...~. ..............
House No. Street Hamlet
qnwer or Owne'rs of Property ....... ~X~....~.~.~/~. ......................................
~ounty Ta~ Map ~o ~000, Section ..... .0~ ........... ..~loc~. ,. ~ .~ot ..................... 4.7
Subdivision .............................. Filed Map ......... Lot .. .
i~ermit No..~. ~. ~.Z~. Date Of Permit .~ .~/~ .~./.Appl ican .~..A~ ~
lealth Dept. Approval...o.... ............ .. ... . Underwriters Approval ................... .... . .
Planning Board Approval ....... ~...~ ......
,~ef,
~equest for: Temporary Certificate ..... Final Certicate ...........
/vi- ................
H_L ~Td . '
-t
3. Naturc of work (check which applicable): New Buddin ..../.. . '
Repm.r ............. Ro~,,,,,~ g ....... Additic, n .......... t'k]tcratzon ...
Tennzs Court' .... :.. ~"'"".'""~ ..... ° ........ Demolition .............. g',-'imn{n,,- '"o-' ......
,- . 4/ ,t · aCCessory Buildine .... , - o .............
4. =mmatcdCostZ..,~_..,,¢'",,¢ ~'~ ....... ,'eq,,,¢~ ....... u~t,~ot-I/' . ........
--.-.,,., ........................... ~,, ... :.,'~...~,. ~..~. ...... , ...............
5. we mZ. nUmberofdwclllngunits ....... Number ofdwclling units on each fl
Cars oo .............. . .....
if, .............. &;' ;~" 'i&';i ........ ~ ......
6. [f business. COmmercial or mixed occupancy, spec nature and c.xtent of ~ t e o .... .
~'- Dimensionsofcxist ngatructures, ifany: Front. · ......
" ............... i'"~ .... ~..r~ca~- ~'~'~ ~ Oep., ~ ~
DH~ gl Nu,nbcr or Stories ..... .
men$ions o£ same structure with alterations or additions: Front ..... Rear ....
Depth .... ·
.................. .e~ .......... 3 " ~"ddJ Jr ' i ~ ~ .... ~ ....
8.Dimensions of entire new construction: Front ....
.......... u .S£orics ........
Heiuht .... . ..... Rear ........ Depth ..
............ Number of Stories .............. : ...
9 Si £ I Fi '
· Ze O Or: oat ........ . ......... - ....
o r~ ~ ' ~ ~'. ....~ ............
10 ......... car .... · ......
· ate O ~rc .'lse , ,. '' ' ' ..... · Depth
I Z di i ti 't ........................ Name of Former Owner .....................
2' D°ne orusc Str c n xv rich premises are situated .......
. Des proposed Construction violat, an nih ....................................................
13 Willl t b d d y zo I d~nance or re-ul '
14. Name of Owner of premL~es .. o ' ....... ~ ...... Wdl excess fill be removed from pre. mi~es: Yea ...
Nam ora hit ................ Addre.~ ................... N [ . '
¢ rc eot ....... Phone o ........
Nam fC .................... Address Ph
eD ontraCtor. - .... · ..... . .... one o. . ......
......................... Address ........ Phone No.
with in' 3{]0 .........................
IX.L,: t. kia prOperty Located feet of a I-idal wetland? '*YES .... IlO ....
~:If yes, Southold Town Trustees Permit may be required.
PLOT DIAG RAM
Lo¢~t~ c]e~ly ~d dist~ctly ~I buHd~gg, whether'existing or proposed, ~d. indicat~ ~I set-back dLm:n:~oaz f:- ~''
~rop~y Hne~. Givz street ~d block number or description accord~g to
ntedor or comcr lot. deed, ~d show street n~es and ~dicate ~ .......
/ ]
FA TE 0 F NEW '~.O R~ff_~,, z/ S.S
DUNTY OF...Q~.
(Name of individual signing c~ntract) '"
o~e nam'cd.
~aid Owner or owners.
~liCauon: [h3t all statements contaiucd in this application arc lrt~c to thc best of his knowledge and bclicf; and that
tk will D~ perl'om~cd in the m~ncr set forlh in the application filed therewith.
om 1o bcl'orc me this
FORM NO. 1
TOWN OF SOUTHOLO
BUILDING DEPARTMENT
TOWN HALL
~OUTItQL.Q. ~L'¢o 1.1.871.
TEL.: 705,1802
I~OAaD OF HEALTtl .........
3 SETS OF PLANs ..........
SURVEY ...................
ClIECK
· ;j~;, ...............
SEPTIC ..............
Ex=mined ................ , 19...
^pp,o,.e,
D;sapprovcd Mc
(Building Inspector) ,
IAPPLI~ATIO~ VO~ BUILDING PERMIT
t;OTI FY ~
CALL .................
I'IA [ L
Date ................ · I9.
IHSTRUCTIO iNS
a. 'l"]fis application must bo completely filled in by typewriter or in ink -;,nd submitted to th& Build;n~. incpcCtor, wit.!
ur,areas, and giving a detailed description of l~yout of property must be drawn on thc diagram which is par~ of t~s apF-
:alton. I
¢. The work covered by th.is appli¢~tion may not be commenced bee-re ix ..... e~ _e r,..:,.4.._,
Upon approval of th~s appbcatiou, the Building Inspector will issued a Building Permit to the appiieant.
:hall be kept on the premises avaQable fo;r inspection throu~out the work. Such pen'r
c. No building shall be occupied or used in whole or ~n part for any purpose whatever until a Certificate of Occup:m:
;hall have been granted by the Building Inspector. '
APPLICATION IS HEREBY' MADEit ...... . - ' -
i o mc .uuiiam~ Department for the issuance of a Building Pe..-mit uu:'~nn~: to
3uilding Zone Ordinance o£ th.e Town ~f Sou£~old, Suffolk Count N - '
%gutations, for the Construct' . . . ~', ew Yor!5 and other applicable Laws'. Ordinances
ion .of bullrings, ad. alit ons or alterations, or for removal or demolitio -- e;
~ie ..appu,c.n5 a~rees to,comply with att applicable laws, ordinances buildin- ,-,-..4/,. ~.--.,__ ~'_._ n....~ hc,r '..'1 describ,..
,um~t autnonzen inspccto~ on premises and in buildLn- r .......... '. . =.~_ 7-, JS'e.~-~4//'~=s, ano ragu:olmos, gna t
· { ~l~f:ziling address of applicant)
,tote ,vh. ether appl,cant ,s o,vn.~er,~t, architect, engineer, general contractor, electrician, plumber
4=~e or owner or prem~s=..5-2.0~..~.I. ( bx~..~..~. ................................................
(as on the tax roll or latest deed) ' ''
~apphcant is a corporation, signature oCduly aUthorized officer.
tt~Je or co~,o,~te
Plumber's License No ........... , ............
Electrk/an's Lken=e No .......................
Olher %ade's License No ........ .............
Location of land o3w~ch proposed ~gdrk will bc~ne; a ~ ff _ '
.. .. . ...... .., ........ ...........
"' ' i ..... ~'~"~ .... .03... ' · -x ~
, . . ...... ~ot ...~./. ......
Subdivision ..................... ................ Eilud M~p No, ' z' ' '
(N:,mc) .............. Loi ...............
SI~Ic cxiHjn= usc and occupancy o¢ pram,scs ~nd mlcndcd usc end ·
, i °ccnpnncy oF proposed constrt~cliofl:
, . ,,: ....